J Korean Rheum Assoc.  2007 Sep;14(3):242-250. 10.4078/jkra.2007.14.3.242.

Anti-TNF-alpha Therapy in Rheumatic Diseases with Chronic Hepatitis B Virus Infection

• Yun HR
• Kim TJ
• Kim TH
• Choi HS
• Bae SC

• KMID: 2202173
• DOI: http://doi.org/10.4078/jkra.2007.14.3.242

Abstract

OBJECTIVE
To assess the safety of anti-tumor necrosis factor (TNF)-alpha therapy in patients with rheumatic disease and chronic Hepatitis B virus (HBV) infection.
METHODS
We used infliximab or etanercept therapy in patients with rheumatic disease and chronic HBV infection. Records concerning these patients were retrospectively reviewed for the duration of disease, treatment, serological status and biological data.
RESULTS
Six relevant cases with chronic HBV infection were identified: three of RA; three of AS. Four patients had received etanercept; two had been given etanercept after infliximab. One of the cases treated with lamivudine before anti-TNF-alpha therapy for chronic hepatitis B treatment. His hepatitis status was maintained stable after he initiated anti-TNF-alpha therapy. Five of the cases started anti-TNF-alpha therapy without lamivudine. Two of these five cases were received lamivudine during anti-TNF-alpha therapy due to elevation of HBV DNA titer without liver function test abnormality and then HBV DNA was normalized. Three cases without lamivudine continued to show the stable level of liver enzyme but, one of the three cases showed persistently elevated HBV DNA titer.
CONCLUSION
Prophylactic or early intervention strategies with anti-viral agent and regular monitoring of aminotransferases and viral load are needed for patient with evidence of chronic HBV infection.

Keyword

Anti-TNF-alpha; Rheumatic disease; Hepatitis B virus

MeSH Terms

DNA
Early Intervention (Education)
Hepatitis
Hepatitis B virus
Hepatitis B, Chronic*
Hepatitis, Chronic*
Humans
Lamivudine
Liver
Liver Function Tests
Necrosis
Retrospective Studies
Rheumatic Diseases*
Transaminases
Viral Load
Infliximab
Etanercept
DNA
Lamivudine
Transaminases

Figure

• 

  Fig. 1. HBV viral load and ALT level during anti-TNF- α therapy in patient 3. ALT: alanine aminotransferase.

• 

  Fig. 2. HBV viral load and ALT level during anti-TNF- α therapy in patient 4. ALT: alanine aminotransferase.

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